Advocacy Intervention Does Not Produce Meaningful Improvement in Depression Among Abused Chinese Women


Among Chinese women who are survivors of intimate partner violence, an advocacy intervention that included empowerment sessions and telephone support from social workers did not result in a clinically meaningful improvement in depressive symptoms, according to a study in the August 4 issue of JAMA, a theme issue on violence and human rights.1

Intimate partner violence (IPV) against women can have negative mental health consequences for survivors, including depression.  Advocacy interventions aim to enhance abused women’s self-care by helping them to make sense of the situation, identify potential solutions, and achieve the goals they have set.  

Agnes Tiwari, Ph.D., of the University of Hong Kong, China, and colleagues conducted an assessor-blinded randomized controlled trial of 200 Chinese women 18 years or older with a history of IPV.  The trial was conducted from February 2007 to June 2009 in a community center in Hong Kong to determine whether an advocacy intervention would improve the IPV survivors’ depressive symptoms. 

The intervention consisted of a 30-minute empowerment session delivered by a registered social worker, focusing on enhanced choice making and problem solving combined with safety assessment and planning.  It was followed by weekly telephone support from the same social worker.  Women in the control group received the usual community services—including child care, health care and promotion and recreational programs.

Women in both groups reported average rates of severe depression at baseline, moderate depression at three months, and mild depression at nine months.

“After adjusting the baseline values, the intervention effects on the changes at three and nine months did not significantly differ,” the authors report.

Women in both groups reported an initial increase in average rates of partner psychological aggression, and then low rates at the completion of the study. 

In the follow-up telephone support calls, the women’s expressed needs focused on parenting problems and rarely on problems with their intimate partners.

“In this randomized clinical trial of an advocacy intervention for community-dwelling abused Chinese women, the intervention did not result in a clinically meaningful improvement in depressive symptoms,” the authors conclude.

In an accompanying editorial2, Angela J. Taft, Ph.D., of La Trobe University, Melbourne, Australia, and Kelsey L. Hegarty, M.B.B.S., Ph.D., of the University of Melbourne, write that designing, implementing, and evaluating interventions for abused women remains a challenge.

“The findings of this study suggest that authors of future trials of interventions for abused women should set realistic clinical goals; collect, interpret, and analyze their data as rigorously and dispassionately as was done in this study; and measure study outcomes that may be clinically or socially meaningful for the study participants, such as parenting issues and children’s needs,” they write.

“The results of the study by Tiwari et al do not support the use of brief interventions delivered by social workers for women experiencing depressive symptoms associated with IPV as defined by the World Health Organization, but the rigorous methods of this trial will help to inform future studies of this pervasive, global threat to women’s health and well-being,” they conclude.


1. JAMA. 2010;304[5]:536-543. 

2. JAMA. 2010;304[5]:577-579.